Ungual hyalohyphomycosis caused by Penicillium citrinum successfully treated with fosravuconazole
Abstract
Dear Editor, The genus Penicillium, which contains over 300 species, is an ascomycetous fungal group that is part of the mycobiome of many species and is of major importance in the natural environment, food spoilage, and food and drug production. Most species are encountered as contaminants. Some infrequently appear as human pathogens.1 Exceptionally, Talaromyces marneffei (Penicillium marneffei) is a human dimorphic pathogenic fungus.1 Occasionally, Penicillium species have been reported to cause onychomycosis; however, the species epithets were rarely stated or inadequately described.2 We report the first documented case of onychomycosis caused by Penicillium citrinum. A 66yearold healthy female homemaker visited our clinic in October 2017. She had noticed white and brown discoloration on her left big toenail 1 year previously (Figure 1a). Although oral terbinafine for 12 months resulted in remission and cured the tinea unguium of her right big toenail, the lesion recurred in January 2019. The clinical subtype was proximal subungual onychomycosis (Figure 1b). Although the clinical subtype was the same, the lesion may have initially demonstrated a mixed infection with dermatophytes (Figure 1a). Direct microscopy of the nail specimen revealed septate hyphae, pigmented and hyaline conidia, and metulae (Figure 1c). Histopathologically, periodic acid– Schiff staining showed mycelium and conidia (Figure 1d). Plate culture on Sabouraud’s dextrose agar at 25°C for 2 weeks yielded…
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